157P
Screening for Substance Abuse in Child Welfare: Timing Matters
Parental substance abuse is a strong predictor of child maltreatment and permanency outcomes in child welfare. Once in the system, substance abusing parents must demonstrate quick progress to avoid termination of parental rights (as required by the Adoption and Safe Families Act of 1997). Given barriers to problem identification and service referral, timely engagement in the treatment process may be critical to recovery and reunification. Because untreated substance abuse delays reunification, children removed from such families tend to remain in care for extended stays. Since 2000, Illinois has been experimenting with an intensive case management model (Recovery Coach) to help speed up the recovery process and increase the likelihood of family reunification. This approach has proven successful, yet effects are relatively small. The purpose of the current study is to investigate if the effects of the case management intervention vary by the timing of contact between mothers and recovery coaches. We focus on the time it takes to screen parents associated with foster care placements. Specifically, we investigate the relationship between a timely substance abuse assessment and critical child welfare outcomes. We hypothesize that early identification and timely engagement improve the odds of family reunification.
Methods and Results:
This study utilizes an experimental design, as parents are randomly assigned to either the control (services as usual) or experimental (intensive case management) group. The sample includes 1,475 women (78% African American) from Chicago, Illinois. As parents are often not present at the temporary custody (TC) hearing, significant delays can emerge between child removal from the home and identification and referral for substance abuse services. In the current study, only 50% of mothers are screened within seven days of the TC hearing. More than two months lapse for 34% of substance abusing mothers. After three years, approximately 24% achieve reunification: there is a significant difference in reunification rates between experimental and control groups (27% vs. 22%). When the timing of assignment and first contact is considered, the effects associated with the intervention increase. Specifically, for experimental group families, making contact within the first week subsequent to TC, 32% of mothers achieve reunification as compared with only 21% in the control group. This effect remains in multivariate life history models even after controlling for other important covariates (Exp(B) = 1.58).
Conclusions and Implications:
Substance abusing families present major challenges for child welfare systems. Once in the system, substance abusing families consume significant resources, as chances for termination of parental rights remain high and odds of reunification remain low. In response, many States are experimenting with innovative strategies to improve treatment-related and child welfare outcomes. Findings from the current study clearly indicate that timing matters. Mothers connected with intensive case management services quickly (within a week of TC) are more likely to achieve family reunification. Intensive case management works, although the effects of this approach seem to diminish as time passes. The challenge now involves determining (1) how to get parents to TC hearings and (2) how to best engage families in a timely manner.